Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0119000922 | VA |
N | 225XH1200X | Occupational Therapist - Hand | 0119000922 | VA |
NPI | 1225146541 |
---|---|
Provider Name | Cynthia Cooper |
First Address | Virginia Beach, VA 23462-1832 |
Second Address | Virginia Beach, VA 23454-2440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2006 |
Last Update Date | 12/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010214050 | (05) | VA |
Q21116 | (02) | VA |